It is difficult to insert long-term dialysis catheters after severe stenosis or occlusion of the internal jugular vein and innominate vein. We used REcanalisation and balloon-oriented puncture for Re-insertion of dialysis catheter in nonpatent central veins (REBORN) in seven patients with severe central venous lesions, and all patients were inserted with long-term dialysis catheters successfully. None had severe complications such as pneumothorax, hemothorax, or pulmonary embolism during operation. All catheters functioned well after postoperative follow-up of 2 months. REBORN provides a novel approach to establish difficult dialysis pathways.
Humans ; Catheterization, Central Venous/adverse effects* ; Catheters, Indwelling ; Renal Dialysis ; Jugular Veins ; Punctures

BACKGROUND: Kidney transplantation (KT) remains to be the preferred mode of renal replacement therapy as it offers the best clinical outcomes, a better quality of life, and lesser complications compared to dialysis. However, KT still carries a number of complications, one of which is graft thrombosis. Despite advancements in treatment, graft thrombosis is still an important cause of early graft loss. Prevention therefore, is of significance. A growing number of evidence suggests that low-dose aspirin has a role in the primary prevention of allograft thrombosis. RESEARCH QUESTION: Among renal transplant recipients, does postoperative aspirin prevent early renal allograft thrombosis? OBJECTIVE: To conduct a meta-analysis to determine the effect of postoperative aspirin on preventing renal allograft thrombosis. METHODS: A systematic search of PubMed, Google Scholar, CENTRAL, and clinicaltrials.gov was done by two independent authors. All randomized and non-randomized studies determining the effect of postoperative aspirin on renal vein/allograft thrombosis were reviewed for eligibility and quality assessment. Studies on both adult and pediatric kidney transplant recipients were included. RESULTS: Five non-randomized cohort studies (3 in adults, 2 in children) with a total of 2,393 patients were included. Using the Newcastle-Ottawa scale, two studies were found to have good quality, while three had poor quality. In a fixed-effects meta-analysis, aspirin was associated with a reduced risk for renal allograft thrombosis in adults (RR 0.13; 95% CI 0.06, 0.28;I2 22%) and children (RR 0.11; 95% CI 0.03, 0.40; I2 0%). CONCLUSION: Post-operative aspirin was associated with reduced risk for renal allograft thrombosis in both adults and children. However, the best available evidence is limited to observational studies. A well-designed randomized controlled trial is needed to confirm this finding.
Aspirin ; Kidney Transplantation ; Renal Veins ; Venous Thrombosis ; Transplantation, Homologous ; Kidney Diseases ; ; Veins ; Allografts

Nutcracker syndrome (NCS) refers to left renal vein compression with impaired blood outflow. The etiology of NCS has been attributed to various anatomic anomalies. Posterior NCS is caused by compression of the retroaortic left renal vein between the aorta and spine. The classic symptoms of NCS include left flank pain with gross or microscopic hematuria. The frequency and severity of the syndrome vary from asymptomatic microhematuria to severe pelvic congestion. For this reason, diagnosis of NCS is difficult and often delayed. Here, we report a case of posterior NCS that was incidentally discovered.
Aorta ; Diagnosis ; Estrogens, Conjugated (USP) ; Flank Pain ; Hematuria ; Renal Veins ; Spine

Central venous disease (CVD) is difficult to treat and often resistant to treatment. In CVD, hemodialysis vascular access should sometimes be abandoned, or in serious cases, the patient's life may be threatened. Therefore, prevention is ideal. However, as the prevalence of chronic kidney disease (CKD) has increased steadily with population aging, CKD patients with a peripherally inserted central catheter (PICC) are encountered frequently. PICCs can cause CVD, and the basilic vein, which is regarded as the important last option for native arteriovenous fistula (AVF) creation in end-stage renal disease (ESRD) patients, is destroyed frequently after its use as the entry site of PICC. The most well-established risk factors for CVD are a history of central venous catheter (CVC) insertion and its duration of use. Therefore, to reduce the incidence of CVD, catheterization in the central vein (CV) should be minimized, along with its duration of use. In this review, we will first explain the basic territories of the CV and introduce its pathophysiology, clinical features, and advanced treatment options. Finally, we will emphasize prevention of CVD.
Aging ; Arteriovenous Fistula ; Catheterization ; Catheters ; Central Venous Catheters ; Humans ; Incidence ; Kidney Failure, Chronic ; Ocimum basilicum ; Prevalence ; Renal Dialysis ; Renal Insufficiency, Chronic ; Risk Factors ; Veins

Whole body ultrasound can be used to improve the speed and accuracy of evaluation of an increasing number of organ systems in the critically ill. Cardiac and abdominal ultrasound can be used to identify the mechanisms and etiology of hemodynamic instability. In hypoxemia or hypercarbia, lung ultrasound can rapidly identify the etiology of the condition with an accuracy that is equivalent to that of computed tomography. For encephalopathy, ocular ultrasound and transcranial Doppler can identify elevated intracranial pressure and midline shift. Renal and bladder ultrasound can identify the mechanisms and etiology of renal failure. Ultrasound can also improve the accuracy and safety of percutaneous procedures and should be currently used routinely for central vein catheterization and percutaneous tracheostomy.
Anoxia ; Brain Diseases ; Catheterization ; Catheters ; Critical Care ; Critical Illness ; Hemodynamics ; Intensive Care Units ; Intracranial Hypertension ; Lung ; Operating Rooms ; Renal Insufficiency ; Tracheostomy ; Ultrasonography ; Urinary Bladder ; Veins

Two dogs presented with vomiting and head pressing. In both dogs, a large vessel was revealed in computed tomography (CT) angiography, which was found to leave the portal vein (PV) cranial to the splenomesenteric confluence and enter the pre-hepatic caudal vena cava cranial to the right renal vein. The flow of portal blood to the liver was not identified. Based on CT angiography, the dogs were suspected to have congenital PV aplasia with portocaval shunting. Diagnostic imaging of potential malformations for PV continuation should be conducted before attempting shunt closure.
Angiography ; Animals ; Diagnostic Imaging ; Dogs ; Head ; Liver ; Portal Vein ; Portasystemic Shunt, Surgical ; Renal Veins ; Vomiting

renal veins which drain the ectopic kidney was found to be persisting subcardinal vein and it is a novel finding. Such ectopic pelvic kidneys are susceptible to blunt trauma, iatrogenic injuries as well as pathologic manifestations.]]>
Abdomen ; Aorta, Abdominal ; Cadaver ; Colon, Sigmoid ; Deception ; Humans ; Kidney ; Male ; Pelvis ; Renal Veins ; Sacrum ; Veins

renal arteries originating not only from the aorta but also from the testicular artery was found in a 75-year-old Korean male cadaver. Three renal arteries arose from the lateral aspect of the abdominal aorta on the right side and four from the left side. Two additional renal parenchymal branches originated from the left testicular artery, accompanied by a pair of veins out of the four testicular veins on the left side. Embryological development of the urogenital vessels is of particular importance for anatomists and clinicians.]]>
Aged ; Anatomists ; Aorta ; Aorta, Abdominal ; Arteries ; Cadaver ; Humans ; Male ; Renal Artery ; Veins

renal venous origin are limited. This information is important in various surgical and clinical procedures including venous embolization, vascular reconstruction during renal transplantation and localizing the source of origin of a pelvic mass. We examined 94 sides of 47 formalin fixed female cadavers and noted the course and termination of ovarian veins. We measured the diameter of ovarian veins at their termination point and the termination distance in respect to the termination point of renal veins at inferior vena cava (IVC) on respective sides. We found two cases of variations related to right ovarian vein -one, right ovarian vein joined the right renal vein; two, right ovarian vein duplicated and joined with IVC at two different points. We found one case of variation related to left ovarian vein—a partially duplicated left ovarian vein. All the variations were unilateral. The mean diameters of right and left ovarian veins were 3.66±1.18 and 4.20±0.96 mm, respectively. The distance of termination of ovarian veins ranged from 19–40 mm and 13–41 mm, respectively from termination points of right and left renal veins at IVC on respective sides. Our study presents a set of data regarding variation of ovarian veins, diameters and termination distances which could be useful for gynecologists, surgeons and radiologists.]]>
Cadaver ; Female ; Formaldehyde ; Humans ; Kidney Transplantation ; Renal Veins ; Surgeons ; Veins ; Vena Cava, Inferior

PURPOSE: Computed tomography (CT) is the most useful diagnostic modality for staging renal cell carcinoma (RCC). However, CT is limited in its ability to predict renal sinus fat invasion (SFI). Here, we aimed to evaluate whether preoperative neutrophil-to-lymphocyte ratio (NLR) could predict pathological SFI in patients with RCC of ≤7 cm for whom preoperative imaging reveals potential renal SFI. MATERIALS AND METHODS: We reviewed the medical records of 1311 patients who underwent extirpative renal surgery for non-metastatic RCC of ≤7 cm between November 2005 and December 2014. After excluding patients with no SFI in preoperative imaging, unavailable preoperative data, and morbidity affecting inflammatory markers, a total of 476 patients were included in this study. Multivariate logistic regression analysis was used to evaluate predictors of pathological SFI. RESULTS: We implemented a cut-off value of 1.98, which was calculated by ROC analysis to obtain high (≥1.98) and low (<1.98) NLR groups. A total of 93 patients with pathological SFI had larger clinical tumor size, higher preoperative NLR, larger pathological tumor size, more frequent renal vein involvement, and higher Fuhrman nuclear grade. Multivariate analysis indicated that high NLR [odds ratio (OR) 2.032, p=0.004], clinical tumor size (OR 1.586, p<0.001), and collecting system involvement on preoperative imaging (OR 3.957, p=0.011) were significantly associated with pathological SFI in these tumors. CONCLUSION: Preoperative high NLR was associated with pathological SFI in patients with RCC of ≤7 cm and presumed SFI on preoperative imaging. Greater surgical attention is needed to obtain negative margins during partial nephrectomy in these patients.
Carcinoma, Renal Cell ; Humans ; Logistic Models ; Lymphocytes ; Medical Records ; Multivariate Analysis ; Nephrectomy ; Neutrophils ; Renal Veins ; ROC Curve